Related Experiment Video
Updated: Jul 8, 2025

Real-time fMRI Biofeedback Targeting the Orbitofrontal Cortex for Contamination Anxiety
Published on: January 20, 2012
Exposure and response prevention versus stress management training for adults and adolescents with obsessive
Joseph A Himle1, Andrew Grogan-Kaylor2, Matthew A Hiller2
1School of Social Work, University of Michigan, 1080 South University Ave, Ann Arbor, MI, 48109, USA; Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA.
Objective:
Though exposure and response prevention (ERP) is a well-proven treatment for OCD across the lifespan, prior RCTs have not studied adolescent and adult patients with the same ERP protocol relative to an active comparator that controls for non-specific effects of treatment. This approach assesses differences in the effect of OCD-specific exposures in affected adolescents and adults and in response to ERP compared to a stress-management control therapy (SMT).
Methods:
This assessor-blinded, parallel, 2-arm, randomized, ambulatory clinical superiority trial randomized adolescents (aged 12-18) and adults (24-46) with OCD (N = 126) to 12 weekly sessions of ERP or SMT. OCD severity was measured before, during and after treatment using the child or adult version of the Yale-Brown Obsessive Compulsive Scale (C/Y-BOCS), depending on participant age. We predicted that ERP would produce greater improvement in OCD symptoms than SMT and that there would be no significant post-treatment differences across age groups.
Results:
ERP (n = 63) produced significantly greater improvements on C/Y-BOCS scores at post-treatment than SMT (n = 63) (Effect size = -0.72, CI = -0.52 to -0.91, p < .001). ERP also produced more treatment responders (ERP = 86%, SMT = 32%; χ2 = 46.37, p < .001) and remitters than SMT (ERP = 39%, SMT = 7%; χ2 = 16.14, p < .001). Finally, there were no statistically significant post-treatment differences in C/Y-BOCS scores between adolescents and adults assigned to ERP.
Conclusion:
A single ERP protocol is superior to SMT in treating both adolescents and adults with OCD. OCD-specific therapy is necessary across the lifespan for optimal outcomes in this highly disabling disorder, though non-specific treatments like SMT are still all-too-commonly provided.
Related Concept Videos
Operant Conditioning Intervention
In operant conditioning, behaviors that are...
Obsessive-Compulsive Disorder
Behavior Therapy
Exposure therapy is a cornerstone of behavioral treatment for anxiety disorders. It involves systematic exposure to feared stimuli, either in real...
Psychological Responses to Stress
Stress Prevention and Stress Management Techniques III
The Role of Exercise in Stress Management
Regular physical activity is essential for reducing stress and promoting cardiovascular health. Exercise strengthens the heart, enhances blood flow, keeps blood vessels flexible, and helps lower blood pressure, all of which reduce the body's stress response. Research shows that adults who exercise regularly have nearly half the...
Stress Prevention and Stress Management Techniques I
Conscientiousness
Conscientious individuals tend to be organized, responsible, and disciplined. They prioritize completing tasks and following structured routines,...

